Date Published: February 3, 2017
Publisher: Public Library of Science
Author(s): Ilaria Clerici, Davide Ferrazzoli, Roberto Maestri, Fabiola Bossio, Ilaria Zivi, Margherita Canesi, Gianni Pezzoli, Giuseppe Frazzitta, Alfonso Fasano.
to date, there are no medical or surgical treatments for progressive supranuclear palsy (PSP). It is possible to speculate that patients with PSP could benefit from rehabilitative treatments designed for Parkinson’s disease, including the use of robot-assisted walking training.
to evaluate whether the use of the robotic device Lokomat® is superior in PSP patients to the use of treadmill with visual cues and auditory feedbacks (treadmill-plus) in the context of an aerobic, multidisciplinary, intensive, motor-cognitive and goal-based rehabilitation treatment (MIRT) conceived for Parkinsonian patients.
we enrolled twenty-four PSP patients. Twelve subjects underwent a 4-week MIRT exploiting the use of the treadmill-plus (MIRT group). Twelve subjects underwent the same treatment, but replacing the treadmill-plus with Lokomat® (MIRT-Lokomat group). Subjects were evaluated with clinical and functional scales at admission and discharge. The primary outcomes were the total PSP Rating Scale (PSPRS) score and its “limb” and “gait” sub-scores. Secondary outcomes were Berg Balance Scale (BBS), Six Minutes Walking test (6MWT) and the number of falls.
total PSPRS, PSPRS-gait sub-score, BBS, 6MWT and number of falls improved significantly in both groups (p ≤ 0.003 all, except 6MWT, p = 0.032 and p = 0.018 in MIRT-Lokomat and MIRT group respectively). The PSPRS-limb sub-score improved significantly only in the MIRT group (p = 0.002). A significant difference between groups was observed only for total PSPRS, indicating a slightly better improvement for patients in the MIRT group (p = 0.047). No differences between groups were revealed for the other outcomes, indicating that the effect of rehabilitation was similar in both groups.
Lokomat® training, in comparison with treadmill-plus training, does not provide further benefits in PSP patients undergoing MIRT. Our findings suggest the usefulness of an aerobic, multidisciplinary, intensive, motor-cognitive and goal-based approach for the rehabilitation of patients suffering from such a complex disease as PSP.
This trial was registered on ClinicalTrials.gov, NCT02109393.
Progressive supranuclear palsy (PSP) represents the most common form of atypical Parkinsonism, with a prevalence of 6.5 cases/1.000.000 people. The neuropathological hallmark of PSP is a biochemical alteration in the tau protein, which results in a neurodegeneration and gliosis in the basal ganglia, brainstem, prefrontal cortex and cerebellum.
Fig 1 (CONSORT flow diagram) shows the trial profile. No dropouts were recorded during the treatment and all subjects completed the rehabilitative protocols.
The main finding of this study is that a specific aerobic, intensive, motor-cognitive, goal-based and multidisciplinary rehabilitation protocol improves the total PSPRS, PSPRS-gait, BBS and 6MWT scores and the number of falls in PSP patients.
There are several limitations of this study that need to be acknowledged. First, the lack of a control group of not treated patients does not allow to draw definite conclusions on the effectiveness of both rehabilitation protocols. Nonetheless, a comparison of the observed improvements with the 9.7 points per year rate of progression of total PSPRS in untreated PSP patients28 indicates that our results are promising. Second, patients with cognitive impairments were included in the study and this might have affected the results. Another potential limitation of our study is the choice of a sample size of convenience, due to time constraints in carrying out the enrollment of patients. The relatively small number of patients might have determined a lack of statistical power in assessing differences in the efficacy of the two rehabilitation protocols. We should also consider that, being both treatments multidisciplinary and intensive, no large differences in their effects could be observed. The lack of follow-up data is another limitation of this study, since it is unknown how long the gains obtained during the rehabilitation period were sustained after discharge in the two groups of patients.
We showed that the use of Lokomat®, compared to the treadmill-plus training, does not add any further benefit in the context of an aerobic, multidisciplinary, intensive, motor-cognitive and goal-based rehabilitation treatment in PSP patients. Our data confirm the results from previous studies about the beneficial effect of rehabilitation in PSP and emphasize the need to design more specific rehabilitation programs for this group of patients.